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https://www.nice.org.uk/guidance/cg155/chapter/Recommendations#first-episode-psychosis

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Psychosocial Interventions in Reducing Cannabis Use in Early Phase Psychosis: A Canadian Survey of Treatments Offered

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Psychosocial Interventions in Reducing Cannabis Use in Early Phase Psychosis: A Canadian Survey of Treatments Offered

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Charlotte
http://journals.sagepub.com/doi/pdf/10.1177/0706743716639931

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Charlotte
http://journals.sagepub.com.ezproxy.brunel.ac.uk/doi/pdf/10.1177/0308022615621567

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Tom

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The Mental Capacity Act (MCA) is designed to protect and empower people who may lack the mental capacity to make their own decisions about their care and treatment. It applies to people aged 16 and over.

It covers decisions about day-to-day things like what to wear or what to buy for the weekly shop, or serious life-changing decisions like whether to move into a care home or have major surgery.

Examples of people who may lack capacity include those with:

But just because a person has one of these health conditions does not necessarily mean they lack the capacity to make a specific decision.

Someone can lack capacity to make some decisions (for example, to decide on complex financial issues) but still have the capacity to make other decisions (for example, to decide what items to buy at the local shop).

The MCA says:

assume a person has the capacity to make a decision themselves, unless it's proved otherwise

wherever possible, help people to make their own decisions

do not treat a person as lacking the capacity to make a decision just because they make an unwise decision

if you make a decision for someone who does not have capacity, it must be in their best interests

treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms

The MCA also allows people to express their preferences for care and treatment, and to appoint a trusted person to make a decision on their behalf should they lack capacity in the future.

People should also be provided with an independent advocate, who will support them to make decisions in certain situations, such as serious treatment or where the individual might have significant restrictions placed on their freedom and rights in their best interests.

How is mental capacity assessed?

The MCA sets out a 2-stage test of capacity:

1) Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use?

2) Does the impairment mean the person is unable to make a specific decision when they need to? People can lack capacity to make some decisions, but have capacity to make others. Mental capacity can also fluctuate with time - someone may lack capacity at one point in time, but may be able to make the same decision at a later point in time.

Where appropriate, people should be allowed the time to make a decision themselves.

The MCA says a person is unable to make a decision if they cannot:

understand the information relevant to the decision

retain that information

use or weigh up that information as part of the process of making the decision

Helping people make their own decisions

Before deciding a person lacks capacity, it's important to take steps to enable them to try to make the decision themselves.

For example:

does the person have all the relevant information they need?

have they been given information on any alternatives?

could information be explained or presented in a way that's easier for them to understand (for example, by using simple language or visual aids)?

have different methods of communication been explored, such as non-verbal communication?

could anyone else help with communication, such as a family member, carer or advocate?

are there particular times of day when the person's understanding is better?

are there particular locations where the person may feel more at ease?

could the decision be delayed until they might be better able to make the decision?

Is the decision in their best interests?

If someone lacks the capacity to make a decision and the decision needs to be made for them, the MCA states the decision must be made in their best interests.

The MCA sets out a checklist to consider when deciding what's in a person's best interests.

It says you should:

encourage participation - do whatever's possible to permit or encourage the person to take part

identify all relevant circumstances - try to identify the things the individual lacking capacity would take into account if they were making the decision themselves

find out the person's views - including their past and present wishes and feelings, and any beliefs or values

avoid discrimination - do not make assumptions on the basis of age, appearance, condition or behaviour

assess whether the person might regain capacity - if they might, could the decision be postponed?

It's vital to consult with others for their views about the person's best interests.

In particular, try to consult:

anyone previously named by the individual

anyone engaged in caring for them

close relatives and friends

any attorney appointed under a Lasting Power of Attorney or Enduring Power of Attorney

any deputy appointed by the Court of Protection to make decisions for the person

Finding the least restrictive option

Before you make a decision or act on behalf of someone who lacks capacity, always question if you can do something else that would interfere less with their basic rights and freedoms.

This is called finding the "least restrictive alternative". It includes considering whether there's a need to act or make a decision at all.

Where there's more than one option, it's important to explore ways that would be less restrictive or allow the most freedom for a person who lacks capacity.

But the final decision must always allow the original purpose of the decision or act to be achieved.

Any decision or action must still be in the best interests of the person who lacks capacity.

So sometimes it may be necessary to choose an option that is not the least restrictive alternative if that option is in the person's best interests.

Deprivation of liberty

In certain cases, the restrictions placed upon a person who lacks capacity may amount to "deprivation of liberty". This must be judged on a case-by-case basis.

Where it appears a deprivation of liberty might happen, the provider of care (usually a hospital or a care home) has to apply to their local authority.

They'll then arrange an assessment of the person's care and treatment to decide if the deprivation of liberty is in the best interests of the individual concerned.

If it is, the local authority will grant a legal authorisation. If it is not, the care and treatment package must be changed - otherwise, an unlawful deprivation of liberty will occur. This system is known as the Deprivation of Liberty Safeguards.

If you suspect a deprivation of liberty may happen, talk to the care provider and then possibly the local authority.

Advance statements and decisions

An advance statement is a written statement that sets down a person's preferences, wishes, beliefs and values regarding their future care. It's not legally binding.

The aim is to provide a guide for anyone who might have to make decisions in a person's best interests if that person has lost the capacity to make decisions or communicate their decision.

An advance statement can cover any aspect of a person's future health or social care.

This could include:

how they want any religious or spiritual beliefs they hold to be reflected in their care

where they would like to be cared for - for example, at home or in a hospital, nursing home or hospice

how they like to do things - for example, if they prefer a shower instead of a bath, or like to sleep with the light on

concerns about practical issues - for example, who will look after their pet if they become ill

Find out more about making advance statements
An advance decision (sometimes known as an advance decision to refuse treatment, an ADRT, or a living will) is a legally binding decision that allows someone aged 18 or over, while still capable, to refuse specified medical treatment for a time in the future when they may lack capacity to consent to or refuse that treatment.

An advance decision must be valid and applicable to current circumstances. If it is, it has the same effect as a decision made by a person with capacity - healthcare professionals must follow the decision.

If the advance decision refuses life-sustaining treatment, it must:

be in writing, signed and witnessed

state clearly that the decision applies even if life is at risk

People who make an advance decision may wish to consider letting their family, friends and carers know about it.
Find out more about advance decisions
Lasting Powers of Attorney

You can grant a Lasting Power of Attorney (LPA) to another person (or people) to enable them to make decisions about your health and welfare, or decisions about your property and financial affairs.

Separate legal documents are made for each of these decisions, appointing one or more attorneys for each.

An Enduring Power of Attorney (EPA) under the previous law was restricted to making decisions over property and affairs, which includes financial affairs and accessing the person's information.

An EPA made before the Mental Capacity Act came into force on 1 October 2007 remains valid.

Powers of attorney can be made at any time when the person making it has the mental capacity to do so, provided they're 18 or over.

Both an EPA and LPA must be registered. An LPA can be registered at any time, but a personal welfare LPA will only be effective once the person has lost the capacity to make their own decisions.

When acting under an LPA, an attorney (the appointed person) must:

make sure the MCA's statutory principles are followed

check whether the person has the capacity to make that particular decision for themselves - if they do, a personal welfare LPA cannot be used and the person must make the decision

In addition, the Court of Protection will be able to appoint deputies who can also take decisions on health and welfare and financial matters if the person concerned lacks the capacity to make a decision.

They'll come into action when the court needs to delegate an ongoing series of decisions rather than one decision.

If the person concerned already has an LPA appointed, they will not normally need a deputy as well.

The Office of the Public Guardian registers LPAs and EPAs, and supervises court-appointed deputies.

It provides evidence to the Court of Protection and information and guidance to the public.

The Public Guardian works with a range of agencies, such as the financial sector, police and social services, to investigate concerns.

The Court of Protection

The Court of Protection oversees the operation of the Mental Capacity Act and deals with all issues, including financial and serious healthcare matters, concerning people who lack the mental capacity to make their own decisions.

The court also tries to resolve all disputes when the person's carer, healthcare worker or social worker disagree about what's in the person's best interests, or when the views of the attorneys conflict in relation to property and welfare.

The court hears important cases, such as whether the NHS should withdraw treatment, whether a serious medical treatment decision is in a person's best interests, or whether it's in a person's best interests to be deprived of their liberty.

Cases can be brought to the court by family members, as well as advocates and professionals involved in decisions.

Professionals' duties under the Mental Capacity Act

The Mental Capacity Act applies to all professions - doctors, nurses, social workers, occupational therapists, healthcare assistants, and support staff.

These staff and their employers have a duty to ensure they know how to use it.

Most trusts and local authorities will have a Mental Capacity Act lead who provides specialist advice on how the Act works.

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The Mental Capacity Act (MCA) is designed to protect and empower people who may lack the mental capacity to make their own decisions about their care and treatment. It applies to people aged 16 and over.

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https://www.isanyoneelselikeme.org.uk/get-involved/our-research-projects/the-eye-project

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Hannah and Charlotte

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Tom

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The need for early intervention

Before I was all over the place. I had a lot of anxiety problems and stress... the [residential] helped me combat these problems... build my confidence and communication skills...

Alice, 19-25 programme participant

In England 7,500 young people develop an emerging psychosis each year, and 75% of mental health problems emerge before the age of 25[1]. Research has identified the mid-teen years as the time when the onset of psychotic and other serious mental health disorders peaks[2].

Furthermore, a long 'Duration of Untreated Psychosis' (DUP) often leads to a poorer long-term prognosis[3]. It is clear that we need to treat more people at an early stage of their illness in order to avoid the human and financial cost of hospitalisation. The task is finding cost-effective models which reap results.

How we can help

Helps you get your life back - it's AMAZING. Confidence and support and people who really understand how you feel. You find that you are not alone in how you feel.

James, 14-18 programme participant

Since 2007, we have established a series of recovery learning initiatives called Uthink for young people aged 14-25 who are experiencing, or caring for someone with, a mental illness. Our programmes enable young people to improve their mental, emotional and physical wellbeing, helps them feel a sense of real achievement and begin making informed choices and plans for the future involving lifestyle, work and educational goals.

We have developed bespoke programmes for young carers, teenage parents and young people from BME communities. We are now tailoring our expertise in mental health services and support for young people for use in the criminal justice system. We have developed a 'multi-level approach' programme of work that not only targets young people directly, but supports prison staff, including specifically prison nurses. This approach also provides accessible information resources for professionals, young people and families. Young people can also acquire valuable skills, including the chance to gain a recognised Award Scheme Development and Accreditation Network qualification.

What we do

I loved the group, I loved the activities and the energy and enthusiasm of the workers and the people I met.

Dean, Uthink participant

The Uthink programme delivers a number of interventions:

1. Recovery learning programmes for 19-25 year olds who have experienced first episode psychosis: regular group sessions facilitated by an experienced team for a given time period.

2. Residential programmes for 19-25 year olds who have experienced first episode psychosis: an intensive activities agenda that introduces young people to new ideas, new experiences and the opportunity to build greater self esteem and peer support. The only programme of its kind in the country.

3. Modular Emotional Wellbeing programmes for 14-18 year olds who have experience, or are at risk of developing, mental health difficulties: raising awareness and prevention of mental illness as well as offering an early intervention for young people demonstrating signs of mental illness.

4. Engagement with schools and colleges by developing and delivering information packs for schools and programmes in educational venues: raising awareness of mental health amongst pupils, teachers and people working within each setting, changing attitudes, tackling stigma and improving access to advice, information and support.

5. Online information and support for young people who have an experience of living with mental illness carers, siblings and friends: offer advice, information and support and encourage peer to peer support. The information and self-help sheets comprise a guide to good mental health as well as techniques for managing the effects of mental illness, developing support structures and signposting help.

6. Leadership training events: fun interactive days providing skills for public speaking, planning and organising activities and taking part in local forums etc.

Evaluation

Independent analysis by the University of Central Lancashire shows strong positive outcomes in areas of managing mental health, self care, daily living skills, development of social networks and relationships, reduced addictive behaviour, improved self-esteem and stronger feelings of trust and hope. Our interim outcomes data set indicates that after participation in Uthink young people demonstrated substantial gains in all dimensions represented in the Recovery Star[4] and with the exception of drugs and alcohol, these improvements were statistically significant.

On completing a Uthink programme, a number of young people have resumed attendance at school or college and/or have begun to look for further training and education opportunities.

Find local support

Find services and support groups near you

We provide a range of services nationally, including advocacy, carer support, crisis services and more.
Click here to find groups and services in your area

Need practical advice & info? We can help.

Contact our Advice team about mental health & related issues

0300 5000 927 Monday - Friday 9.30am - 4pm, not including bank holidays

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Before I was all over the place. I had a lot of anxiety problems and stress... the [residential] helped me combat these problems... build my confidence and communication skills... Alice, 19-25 programme participant In England 7,500 young people develop an emerging psychosis each year, and 75% of mental health problems emerge before the age of 25[1].

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Tom

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Shepherd House is an inpatient recovery unit and community hub for clients experiencing psychosis. It offers intensive rehabilitation using psychological, psychosocial, physical and medical approaches.

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Shepherd House is an inpatient recovery unit and community hub for clients experiencing psychosis. It offers intensive rehabilitation using psychological, psychosocial, physical and medical approaches.

# data[].attributes.body
Tom

# data[].attributes.attachment_link.readable_text
The Care Act 2014 sets out in one place, local authorities' duties in relation to assessing people's needs and their eligibility for publicly funded care and support.

Under the Care Act 2014, local authorities must:

carry out an assessment of anyone who appears to require care and support, regardless of their likely eligibility for state-funded care

focus the assessment on the person's needs and how they impact on their wellbeing, and the outcomes they want to achieve

involve the person in the assessment and, where appropriate, their carer or someone else they nominate

provide access to an independent advocate to support the person's involvement in the assessment if required

consider other things besides care services that can contribute to the desired outcomes (e.g. preventive services, community support)

use the new national minimum threshold to judge eligibility for publicly funded care and support.

Assessment and eligibility resources

SCIE has developed a range of resources to support local authority staff, social workers and others involved in assessment and eligibility.

Implementation support

Related information
Fair access to care services (FACS): prioritising eligibility for care and support
Care and support reform programme
Care Act 2014: statutory guidance for implementation
Keep up to date

Make sure you know when we publish our new resources on the Care Act. Register for the SCIELine ebulletin.

To register for the Care and Support Reform bulletin, email CareBillReform@local.gov.uk

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The Care Act: Assessment and eligibility

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Care Act 2014 - Assessing people's needs and eligibility for funded care and support. Information on what local authorities must do under the Care Act. Assessment and eligibility resources including a process map, self assessment examples and guide, eligibility examples and videos. SCIE can help with Care Act implementation and support.

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Sahra

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Statutory Code of practice: Mental Health Act 1983

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Statutory Code of practice: Mental Health Act 1983

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Sahra

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Shows professionals how to carry out their responsibilities under the Mental Health Act 1983, and provide high quality and safe care.

Documents

Details

As well as providing guidance for professionals, the revised code of practice also guides patients, their families and carers on their rights.

The code was revised to take account of stakeholders' views during our consultation, and reflects changes in legislation, case law, policy and professional practice since its last revision in 2008. The response to the consultation was published on 15 January 2015.

The easy-read version covers the same chapters that were covered in the easy-read consultation document.

The code of practice is effective from 1 April 2015. It has been prepared in accordance with section 118 of the Mental Health Act 1983.

Further guidance on implementing changes to police powers and places of safety provisions in the act was published in October 2017.

Printed copies of the code of practice are available from The Stationery Office

Thank you for your feedback

Report a problem with this page

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Code of practice: Mental Health Act 1983

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Shows professionals how to carry out their responsibilities under the Mental Health Act 1983, and provide high quality and safe care.

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Statutory Mental Health Services for Young People

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Statutory Mental Health Services for Young People

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Sahra

# data[].attributes.body
Sahra

# data[].attributes.headline
Statutory Psychosis and schizophrenia in children and young people: recognition and management

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Statutory Psychosis and schizophrenia in children and young people: recognition and management

# data[].attributes.body
Sahra
https://www.nice.org.uk/guidance/cg155/chapter/Recommendations#possible-psychosis

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Psychosis and schizophrenia in children and young people: recognition and management | Guidance and guidelines | NICE

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Evidence-based recommendations on recognising and managing psychosis and schizophrenia in children and young people

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When California legalised the recreational use of cannabis this month, it also triggered an international debate: is it time to recognise the benefits of a drug once associated with criminal gangs and free-loving hippies? Or is there an urgent need for a crackdown?

Almost two-thirds of Americans are in favour of relaxing marijuana laws, according to an October 2017 Gallop poll, but critics warn the move sends the message that the psychoactive drug is safe to use - a conclusion that many dispute.

With the recreational use of cannabis now permitted in eight US states, and many European countries including Norway moving towards legalising or decriminalising the drug, The Week looks at the associated health risks and medical benefits.

What do supporters say?

Cannabis has long been promoted as an effective treatment for a host of medical conditions, including epilepsy and chronic pain.

The California Medical Association is among the doctors' groups that have called for the full legalisation of marijuana, arguing that the drug "should be strictly regulated like medicine" to ensure safe and appropriate use by patients with legitimate health problems.

Supporters also argue that legal recreational drugs such as alcohol and tobacco pose a far greater risk.

"In several respects, even sugar poses more of a threat to our nation's health than pot," says clinical psychologist David Nathan in an article for the CNN website.

Reporter Christopher Ingraham, who covers drug policy for The Washington Post, agrees. It takes "extraordinary chutzpah to rail against the dangers of marijuana use by day and then go home to unwind with a glass of far more lethal stuff in the evening", Ingraham writes.

What do critics say?

In the Los Angeles Times, political columnist George Skelton asks: "Why the hurry to legalise consumption of another poison? We've already got alcohol, which can ruin lives. Tobacco causes cancer. Cannabis? It can mess up the mind. Plenty of research shows that."

Opponents also claim that the potency of the drug has increased dramatically in recent years, especially when consumed in food and drinks.

Modern marijuana "isn't like the crappy pot you were smoking in college", says Andrew Acosta, spokesperson for the campaign, which fought against legalisation in California.

"This is high-grade stuff they're putting in candy bars and you're climbing the wall."

What are the medical benefits?

Despite being listed as a Schedule 1 drug in the US - a classification that defines a drug as having "no currently accepted medical use and a high potential for abuse" - marijuana and its many derivatives have been found to be beneficial in treating or alleviating some health conditions.

In one of the most wide-ranging studies on the health effects of recreational and therapeutic cannabis use to date, the US National Academy of Sciences, Engineering and Medicine last year published a comprehensive review of 10,000 research papers.

The review found "conclusive or substantial evidence" that cannabis or its other compounds, known as cannabinoids, can be an effective treatment for chronic pain, muscle spasms associated with multiple sclerosis, and chemotherapy-induced nausea and vomiting.

Separately, a clinial trial published in The New England Journal of Medicine last year found cannabidiol, a marijuana derivative, to be beneficial in the treatment of a complex childhood epilepsy disorder.

Gregory Gerdeman, a neuroscientist who specialises in the physiological actions of cannabis, says it is "already widely understood that marijuana is valuable and safe as a palliative medicine, which undermines the tenets of the Schedule 1 status", reports Time magazine.

Additionally, there are anecdotal patient reports, increasing numbers of clinical case studies and a wide range of pre-clinical studies that indicate cannabinoids could also help shrink some of the most serious types of tumours, Gerdeman told Time.

However, scientists say more research is needed to determine whether the drug can serve as an effective cancer therapy.

What about the risks?

Cannabis is roughly 114 times less deadly than alcohol, according to research published in 2015. But it's important to note that "safer than alcohol" doesn't mean "safe, full stop", says The Washington Post's Ingraham.

One of the biggest concerns is marijuana's effect on mental health. The NHS website warns that regular cannabis use increases a person's risk of developing a psychotic illness, such as schizophrenia. The risk increases if a person starts using cannabis at a young age, smokes stronger types of the drug, such as skunk, or smokes regularly or for a long time, the health service says.

In a 2015 study, King's College London researchers found that people who smoked skunk every day had five times the normal risk of psychosis.

However, such studies "do not prove beyond doubt" that cannabis causes mental health problems, says The Guardian 's health editor, Ian Sample.

The NHS also suggests that heavy cannabis users are more likely to develop bronchitis, but researchers have drawn varying conclusions. Some studies point to the positive effects of tetrahydrocannabinol (THC), the principal psychoactive ingredient of cannabis, on opening the airways, while others highlight the negative outcomes of marijuana smoke inhalation, according to the US Lung Institute.

Ultimately, says scientists, far more research into the drug is needed.

"It's actually quite amazing how little we really know about something that has been used for thousands of years," says Sachin Patel, of Tennessee's Vanderbilt University, who studies cannabis.

"We desperately need well-controlled unbiased large-scale research studies into the efficacy of cannabis for treating disease states, which we have very little of right now," Patel told Time.

So what is the consensus?

The evidence suggests cannabis is a relatively safe drug that provides a host of medical benefits, but that it is not harmless and that its potential risks to physical and mental health should not be ignored. More research is needed to determine whether or not the long-term risks outweigh the rewards.

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The truth about marijuana's health effects

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When California legalised the recreational use of cannabis this month, it also triggered an international debate: is it time to recognise the benefits of a drug once associated with criminal gangs and free-loving hippies? Or is there an urgent need for a crackdown?

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Stigma in families of individuals in early stages of psychotic illness: family stigma and early psychosis

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Stigma in families of individuals in early stages of psychotic illness: family stigma and early psychosis

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Sahra
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748954/

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Abstract

Aim

Stigma is pervasive among families of individuals with psychotic disorders and includes both general and 'associative' stigma - that is, the process by which a person is stigmatized by virtue of association with another stigmatized individual. These forms of stigma may present a barrier to help seeking. However, little is known about stigma in the early stages of evolving psychotic disorder.

Methods

Family members of 11 individuals at clinical high risk and of nine patients with recent-onset psychosis were evaluated for generalized and associative stigma using the Opinions about Mental Illness (modified) and the Family Experiences Interview Schedule.

Results

In this small study, the level of stigma was low, as families endorsed many supportive statements, for example, patients should be encouraged to vote, patients want to work, mental illness should be protected legally as a disability and parity should exist in insurance coverage. Families also endorsed that both talking and a belief in God and prayer can help someone get better. Only ethnic minority families of individuals with recent-onset psychosis endorsed a sense of shame and need to conceal the patient's illness.

Conclusions

This preliminary study suggests that family stigma is low in the early stages of psychotic disorder, a finding that requires further investigation in a larger and more representative sample. This may be an opportune time to engage young people and families, so as to reduce duration of untreated illness. Ethnic differences in stigma, if replicated, highlight the need for cultural sensitivity in engaging individuals and their families in treatment.

Keywords: ethnicity, families, prodrome, psychosis, stigma

Introduction

The World Health Organization World Health Report describes stigma as one of the remaining greatest obstacles to the treatment of mental illness. Stigma is the social process that derives from a situation of power imbalance, in which labelling, stereotyping, separation, status loss and discrimination occur. In relation to mental illness, stigma refers to the cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid and discriminate against people with mental illnesses. Across the world, the stigma of mental illness causes immense suffering: its consequences include stress and psychiatric morbidity, problems in relationships, restrictions on social participation and limitations in employment and educational opportunities. Stigma may also interfere with help seeking, as individuals are motivated to avoid the label of mental illness and to avoid being associated with mental health care.

Schizophrenia, in particular, because of its distinctive symptoms, disruptive behaviour and perceived dangerousness, is a target for stigma and discrimination. Persons suffering from schizophrenia and their close family members are such frequent targets of stigma that in 1996 the World Psychiatric Association initiated an international campaign to combat the stigma and discrimination associated with schizophrenia in particular., In the ensuing decade, further reports documented the negative impact of stigma on families of schizophrenia patients, leading to sleep and relationship disturbances, poor psychological well-being and decrement in quality of life. The stigma experienced by family members is described as 'courtesy' or 'associative' stigma, which is the process by which a person is stigmatized by virtue of association with another stigmatized individual. For example, relatives of patients report being stigmatized through assignment of guilt and through experiences of social exclusion and withdrawal by virtue of having a family member with schizophrenia., It has been shown that as many as 70% of caregivers of individuals with mental illness believe that most people devalue patients and that this devaluation extends to their families.

In the early stages of psychosis, it is families who primarily seek help for symptomatic family members. The importance of understanding stigma experienced by families of young people with psychotic symptoms is that it may interfere with help seeking, likely through maladaptive coping and increased thresholds for treatment initiation (Michael Compton, pers. comm., 2008). If families do not seek help because of stigma, young people are at risk for longer durations of untreated illness, especially of psychosis (Michael Compton, pers. comm., 2008), which is associated with worse long-term outcome., One study has demonstrated that stigma is associated with family burden for families of recent-onset psychosis patients. It is of interest whether families' experience of stigma occurs during the evolution of psychotic symptoms in clinical high-risk individuals. These are young people who typically have become somewhat odd and socially withdrawn, with symptoms of dysphoria and anxiety and subthreshold psychotic symptoms; that is, suspiciousness instead of paranoia, illusions rather than hallucinations and overvalued ideas that have not yet coalesced into the fixed false beliefs which constitute delusions.

In this exploratory study, we evaluated stigma experienced by families of not only patients with recent-onset psychosis but also in young people identified as prodromal or at heightened clinical risk for psychosis. It may be expected that behavioural changes in clinical high-risk individuals might lead to some generalized and associative stigma in their families. However, we hypothesized that stigma would be endorsed more by families of recent-onset psychosis patients (as compared with those of ultra high risk individuals) as they would have more experience with psychotic symptoms and treatment systems (especially inpatient hospitalization), and would have dealt with stigmatizing diagnoses.

Methods

Sample

The sample obtained for the present study represents a convenience sample of patients identified from both the New York State Psychiatric Institute at Columbia University and Yale University's Department of Psychiatry. The clinical ultra high-risk group of individuals was identified as prodromal to psychosis using the Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms. Herein, they will be referred to as 'prodromal' individuals. For the recent-onset psychosis patients, diagnoses in New York were made using the Diagnostic Interview for Genetic Studies, whereas diagnoses in the Yale psychiatric system of care were obtained from chart review. Individuals were asked to nominate a preferred identified family member for interview. Individuals provided consent for their family members to be contacted and to be invited to participate. At both sites, family members provided written informed consent for participation.

No participants were excluded or refused to participate. The only exclusion criterion was an inability to speak English and/or inability to give consent, either on the part of the individual or any family member. (Exclusion of individuals who were unable to speak English restricts the representativeness of the sample, in particular regarding putative ethnic differences in familial stigma.) This study was approved by the Institutional Review Boards at the Yale School of Medicine, New York State Psychiatric Institute and the Columbia Presbyterian Medical Center.

Measures

To assess families' general attitudes about mental illness, we used a modified and expanded version of the Opinions about Mental Illness (OMI) scale. The OMI covers salient elements of stigma, such as the linking of mental illness labels to: (i) stereotypes, that is, 'People who are mentally ill let their emotions control them'; (ii) difference, that is, 'There is something about mental patients that makes it easy to tell them from other people'; and (iii) status loss and discrimination, that is, 'Anyone who is in a hospital for a mental illness should not be allowed to vote'. The OMI was modified to reduce social desirability bias, that is, 'All patients in mental hospitals should be prevented from having children by a painless operation' was modified to 'People with mental illness probably shouldn't have children'. Thirteen new items were added to reflect current trends in public attitudes towards mental illness; for example, 'The Americans with Disabilities Act should cover people with mental illness' and 'Celebrities and famous people shouldn't disclose their histories of mental illness'. Each item required a true or false response. To reduce response bias, items were worded either positively or negatively, with a score of 'zero' for the stigmatized response. Therefore, lower scores reflected a more negative attitude towards mental illness, and hence more stigma.

The Family Experiences Interview Schedule (FEIS) primarily assesses family burden; it includes a stigma subscale that probes 'associative' stigma, that is, worry about discovery of illness, concern that others would act differently or avoid the family, the impetus to hide the illness or keep it secret and feelings of shame. As with the OMI, stigmatized responses are scored as 'zero', such that a lower score indicates a greater degree of stigma.

Items from both the OMI and FEIS scales were separately summed to calculate total scores for each scale: chi-squared analyses were done to determine differences in family response by stage of illness or ethnicity.

Results

Sample

There were nine prodromal individuals and 11 with recent-onset psychosis. Both groups were primarily male ( n = 8 per group), although prodromal individuals were younger (15.9 years (standard deviation, SD 2.5) vs. 20.6 years (SD 2.9)) as were their family members (41.1 years (SD 7.9) vs. 47.7 years (SD 7.8)). Additionally, the ethnic distribution of the two groups was different. The family informants for prodromal individuals were primarily white (six of nine), with only two African American and one Hispanic individuals. By contrast, there were equal proportions (three each) of these three groups among family members of recent-onset psychosis patients, with one Asian American and one 'other' (mixed race) family member. Family members were primarily parents, with only three being non-parental caregivers (adult siblings and aunt).

On the OMI Scale, which measures generalized stigma, family members of both groups endorsed a number of 'supportive' items, including that patients should be encouraged to vote, that patients want to work, that mental illness should be protected legally as a disability, that parity in insurance coverage should exist and that believing in God and prayer could help someone get better (). There were no supportive items that were endorsed by fewer than 40% of families. Consonant with this, only a small portion of the families endorsed negative or stigmatized items, that is, patients don't pay attention to how they look; patients can only do basic jobs; children shouldn't visit psychiatric hospitals; that it is easy to tell by looking at someone if they have mental illness; mental illness should be listed on driver's licenses and patients should not be police officers (). No one endorsed the idea that talking doesn't help much with mental illness. There were only a few negative or stigmatized items that had high levels of endorsement (>75%), which included that dealing with a patient could be like dealing with a young child and that mental illness can lead someone to behave in ways that make other people laugh ().

TABLE 1

For generalized stigma, families of prodromal individuals were twice as likely to endorse the idea that people who were once patients in a psychiatric hospital could be trusted as babysitters (). Consonant with this, some 'stigmatized' items were endorsed more by families of recent-onset psychosis patients: more tax money should be spent on building psychiatric hospitals; it is inadvisable to marry someone with mental illness; patients should probably not have children; celebrities should not disclose their history of mental illness; and a psychiatric patient has many things wrong (as opposed to a heart patient) (). These discrepancies, however, may be explained by the ethnic differences between the groups, and differential endorsement by ethnicity.

Associative stigma was endorsed more by family members of patients with recent-onset psychosis than by family members of prodromal individuals (χ ² = 2.22, degrees of freedom (d.f.) = 18, P < 0.05) (). Many of these items were endorsed primarily by the ethnic minority families of recent-onset psychosis patients; for example, worry others would find out about the patient's condition, feeling the need to sometimes hide the illness of their family member and a sense of embarrassment or shame about the illness (). By contrast, generalized stigma was equal in the two family groups (χ ² = 1.70, d.f. = 16, P = 0.11). Ethnic minority families did not differ overall from white families as to associative (χ ² = 0.879, d.f. = 18, P = 0.39) or generalized stigma (χ ² = 1.205, d.f. = 16, P = 0.246).

TABLE 2

The preponderance of associative stigma among these family members of patients with recent-onset psychosis is reflected in qualitative research with this same cohort; for example, concerns that healthy siblings of the patient would be ostracized and teased as a result. By contrast, stigma was not a theme that was prominent among families of prodromal individuals.

Of note, there was no association of associative stigma with subjective or objective family burden (data not shown), which were also measured with the FEIS in this cohort of families of individuals in early stages of psychosis. This is in contrast to a finding of association of burden and stigma in families of first-episode schizophrenia patients using different scales.

Discussion

This is an exploratory study of both generalized and associative stigma in families of young people in early stages of psychotic illness. Overall, the level of stigma was low, though families of patients with recent-onset psychosis endorsed more associative stigma than families of young people identified as prodromal to psychosis.

In this small study, families generally agreed that work is good for patients, believing that individuals with mental illness want to work, and can do more than basic jobs, even assuming the roles of police officers or security guards. This may be promising, as supportive employment programmes have proven efficacious for individuals with psychotic disorder, even those with recent-onset psychosis., Additionally, all families endorsed the need for parity in coverage of mental illness, which is not surprising, given the difficulties they report having with insurance companies. Of note, the Presidential Commission on Mental Health Care has identified unfair treatment limitations and financial requirements placed on mental health benefits in private health insurance as one of the main obstacles preventing Americans from receiving excellent mental health care. Eighteen of the 20 family members interviewed endorsed that believing in God and prayer can help someone get better. This corresponds to other studies that find a high prevalence of religiosity and religious coping in patients with psychosis., Also, all 20 families disagreed with the item 'Talking doesn't help much with mental illness'. Qualitative research and focus groups with family members of patients early in the course of psychotic disorder show that family members greatly desire information.,,, Several specialized services for first-episode psychosis patients have implemented multifamily psychoeducational groups, which have been well received, leading to decreases in reported burden.,

Associative stigma was endorsed at greater rates by families of recent-onset psychosis patients than by families of prodromal individuals, a finding that merits further investigation in a much larger and more representative sample. If replicated, this finding suggests that the development of a psychotic episode and its treatment may increase families' experiences of they themselves being stigmatized, whereas more general attitudes about mental illness may not significantly change. For example, a family member of an individual with recent-onset psychosis articulated: 'The S word - schizophrenia - I'm going to deal with it for the rest of my life.'

Of preliminary interest, there was a greater prevalence of ethnic minorities among families of recent-onset psychosis patients. Although this may be simply due to ascertainment differences of these small convenience samples, this finding is nonetheless consistent with literature suggesting that ethnic minorities, in particular African Americans, are more likely than whites to delay seeking help from voluntary professional mental health services. ⁻ It has been posited that differential stigma among African Americans may account for this racial/ethnic disparity in help-seeking behaviour, a theory lent support by emerging qualitative research data documenting a pervasive fear of the labels of mental illness among African American families of first-episode psychosis patients (Michael Compton, pers. comm., 2008).

A few other preliminary ethnic differences in reported stigma emerged, especially among families of recent-onset psychosis patients, which would be useful to examine in a larger study that was not confined to individuals fluent in English. For example, only a quarter of ethnic minority first-episode families felt that a former inpatient could be trusted as a babysitter, in contrast to two-thirds of ethnic minority family members of prodromal individuals and all white families in the study. This is consonant with documented worries among African Americans about the dangerousness of psychiatric patients, especially those who have schizophrenia. Further, primarily ethnic minority families of patients with recent-onset psychosis endorsed associative stigma items such as a sense of shame and a need to conceal the patient's psychotic illness. This is consistent with findings in the general population that African Americans are more likely to believe that individuals could be 'contaminated' by mental illness in a family member. This theme of contamination may also resonate with minority families' opinions that it is inadvisable for patients to marry or have children, and that they should not disclose their history of mental illness. Of note, however, minority families of prodromal individuals did not endorse any of the associative stigma items, suggesting that stage of illness may have an impact on stigma experience by families of young people early in the course of psychotic disorder.

Limitations

This is a small exploratory study of generalized and associative stigma in families of young people with early stages of psychosis. There are several limitations in this study, the primary one being that stigma was evaluated only in those families who had sought treatment and obtained care for family members in early stages of psychotic disorder. This may be less of an issue for the patients with recent-onset psychosis who had been hospitalized, often involuntarily, as a consequence of the crisis of psychosis onset. However, families of prodromal individuals may be far less typical, in that they accessed care to a specialty clinical research programme. Therefore, stigma is likely greatly underestimated for families of prodromal individuals in general, as the study did not capture individuals with prodromal symptoms (and their families) who are in the community and not receiving care.

Another major limitation in this study is the exclusion of individuals and families who do not speak English, which limits the representativeness of the sample, and which also makes very tentative any apparent findings of ethnic differences in stigma for families. Other limitations include the use of scales that do not have established psychometric properties in family members of patients.

Further study of stigma in families of individuals with evolving psychotic disorders will require larger and more representative samples to determine if these preliminary ethnic differences in stigma are replicable, and to evaluate their relationship to other factors of interest, including socioeconomic status ⁻ and cultural mistrust. ⁻

Acknowledgments

Financial support for this research was provided by the National Institute of Mental Health grant K23MH066279-03 and by a National Alliance for Research on Schizophrenia and Depression Young Investigator Award.

References

5. Link BG, Cullen FT, Frank J, et al. The social rejection of former mental patients: understanding why labels matter. Am J Sociol. 1987;92:1461-500.

7. Sartorius N. Fighting schizophrenia and its stigma. Br J Psychiatry. 1997 Apr;:170-297.

11. Goffman E. Stigma. Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice-Hall; 1963.

12. Mehta S, Farina A. Associative stigma: perceptions of the difficulties of college-aged children of stigmatized fathers. J Soc Clin Psychol. 1988;7:192-202.

26. Tessler R, Gamach G. Toolkit for Evaluating Family Experiences with Severe Mental Illness. Cambridge, MA: Human Services Research Institute; 1995.

45. Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2002.

48. Nickerson KJ, Helms JE, Terrell F. Cultural mistrust, opinions about mental illness, and black students' attitudes toward seeking psychological help from white counselors. J Counseling Psychol. 1994;41:378-85.

50. Whaley AL. Cultural mistrust and mental health services for African Americans. Couns Psychol. 2001;29:513-31.

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Stigma in families of individuals in early stages of psychotic illness: family stigma and early psychosis

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Stigma is pervasive among families of individuals with psychotic disorders and includes both general and 'associative' stigma - that is, the process by which a person is stigmatized by virtue of association with another stigmatized individual. These forms of stigma may present a barrier to help seeking.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748954/

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A year in the lives of inpatients at a teenage mental health unit - This is a 3 part series

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A year in the lives of inpatients at a teenage mental health unit. ** All Copyright(s) are maintained by their respective owner. This film is provided for educational purposes.

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We’re failing our young people on mental health provision

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Letters

The failure to find a specialist bed for a suicidal and vulnerable young woman leaving youth custody is at the heavy end of a much wider problem facing mental health services for young people ( Senior judge warns of 'blood on our hands', 4 August).

First, there are territorial injustices in young people's access to child and adolescent mental health services (Camhs) when problems arise. This often results in long delays in receiving preventive services, sometimes to the point where they just give up hope and suffer in silence while their problems get worse.

Second, there is evidence some vulnerable young people moving on from Camhs at 18 are unable to access the adult mental health services they desperately need, often until a crisis occurs. This is a consequence not just of staff shortages but also differences between adult services and Camhs in their thresholds for services: whereas the former is based on meeting a strict clinical diagnosis, for the latter, the threshold is usually general "wellbeing". This reflects a failure to have a seamless link between child and adult care services during young people's transitions to adulthood.

Finally, the increasing levels of mental health problems and suicides among young people must raise difficult questions about their emotional and material status in families, schools, communities and society. In the words of Sir James Munby: "Have we a right to call ourselves civilised?"
Mike Stein
Emeritus professor, University of York

* In 1996 I edited a book, "Childhood" in "Crisis"? We exposed the systemic demonisation of children and young people alongside the lack of support for families in communities, the erosion of child and youth provision, and the rise of ever-more draconian regulatory responses to children in conflict with the law. Yet the following year the Asbo mantle was eagerly grasped by Jack Straw whose tenure as home secretary tightened the vice.

We warned that the relationship between "austerity" - meaning poverty - social exclusion and harsh measures failed to address one of the most obvious and prevalent issues of the time: mental ill-health in childhood and early youth manifesting in self-harm, alcohol and drug dependency and young people taking their own lives.

During the 2000s the work addressed specific tensions within communities transitioning from generations of conflict to peace. Again, our research demonstrated the devastating impact of economic marginalisation and structural conflict on the mental wellbeing of our children.

It is commendable Sir James Munby has spoken out unambiguously in the case of the risk faced by a young woman if appropriate care is unavailable on her release from youth custody. Less acceptable is the parade of politicians, senior health professionals and academics who have responded so swiftly to an issue that has burned in full view for 20 years.

As so many children and young people took their own lives, were incarcerated in a range of soul-destroying institutions or were left homeless and hopeless, many community-based, independent and local authority essential services were depleted by draconian cuts, their outstanding workers forced out from their dedicated essential support. That it has taken a senior judge to headline the suffering of our children and young people is an indictment of the lack of political will to fully resource essential, community-based services.
Prof Phil Scraton
School of law, Queen's University, Belfast

* The care and support we provide our vulnerable children reflects on us as a society. We score highly on awareness and willingness to act. The government has put in the resources to deliver more staff on the ground over the next four years. Where criticism is valid is on our ability to use these resources effectively to enact change that makes a difference.

The government cannot just put money into the system and sit back and hope that it reaches the front line. There needs to be concerted political leadership to deliver change. The prime minister should establish an implementation taskforce pulling together ministers across government - including health, education, justice and work and pensions. It should focus on ensuring children and young people in crisis receive appropriate care and support, but also that we invest in early intervention and prevention. The tragic plight of this young woman could be added to the long list of similar stories or it could represent a watershed moment in bringing about real change. Let's make sure it's the latter. No child should ever be condemned to the "too difficult to help" box.
Prof Sue Bailey
Chair of the Children and Young People's Mental Health Coalition

* A distressed and suicidal young mother who had just split up from her boyfriend killed her two-year old daughter last October ( Report, 27 July). She then sent a picture of the child to her ex-boyfriend, and called 999 for help. She said the dead child was not breathing. She wrote a note saying, "There's nothing for me or Macey, life's shit." She was found making attempts to revive the child and she, Cody-Anne Jackson, had superficial chest, neck and wrist injuries. At first she denied suffocating the child but later changed her plea. She was sentenced to life imprisonment.

The judge, Michael Chambers QC, said: "This is not a case where you suffered from mental illness" and that the killing was "an expression of utter self-absorption". We are not told what the evidence for these statements was. Is this the best we can do for a distressed and vulnerable young woman, her family, her boyfriend and his family? Where, also, is the concern to prevent such tragedies?
John Gunn
Emeritus professor of forensic psychiatry, Kings College London

* The Five Year Forward View for mental health recognised child and adolescent mental health services as being particularly under-resourced in comparison with other psychiatric services ( Judge's verdict exposes a rapidly growing scandal, 4 August). Yet all mental health services receive only 13% of the NHS budget, despite mental illness accounting for 23% of the UK's total burden of disease.

The February 2017 follow-up report, One Year On, speaks in relation to Camhs of having conducted a "consultative review to consider the local requirements for in-patient beds and make recommendations on how the availability and use of beds can be improved". New beds will be opened, but there is no indication of the timescale, the number of beds, their tier level or their funding. Many boroughs and counties have no Camhs beds after decades of "efficiency savings". NHS England bears full responsibility for this lack, and the resulting harm caused to the most vulnerable children and adolescents in our society.
Morris Bernadt
London
Topics

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We're failing our young people on mental health provision | Letters

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Letters: Mike Stein writes of the wider problems facing mental health services for young people; Phil Scraton writes that this crisis has been in full view for 20 years; Sue Bailey implores the government to set up an implementation taskforce; while John Gunn questions how a mother who killed her child could be condemned by the presiding judge as 'self-absorbed'

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Mental health problems often start in childhood, but opportunities to help are being missed and research spend is lacking

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16 million people in the UK experience a mental illnessOne in four adults will experience a mental illness at some point each year in the UK. This ranges from anxiety and depression to alcohol dependence, substance misuse and psychosis.

Three in four mental illnesses start in childhood
75% of mental illnesses start before a child reaches their 18th birthday, while 50% of mental health problems in adult life (excluding dementia) take root before the age of 15.

10% of school children have a diagnosable mental illness
In an average class of 30 young people, three will have a mental health problem. Figures show 10% of children aged 5-16 have been diagnosed with a mental health problem.

75% of young people with a mental health problem are not receiving treatment
There's been a rise in the time children are having to wait to receive treatment for complex mental health conditions, and children with depression and anxiety are often not being identified or given help.

The average wait for effective treatment is 10 years
It can take a decade for many young people to receive help after showing first symptoms. Opportunities to help are often missed until they reach "crisis", causing children to self-harm, become suicidal, be violent and aggressive or drop out of school.

Suicide is the biggest killer of young people in the UK
Suicide is a leading cause of death in young men and women aged 20-34 in the UK. The latest figures from the Office of National Statistics reveal that the number of young suicides each year is greater than it has been for the past 10 years. In 2015 1,660 young people under 35 years took their own lives; 103 more than in 2014 and 58 more than the previous highest recorded figure (1,631 in 2011).

Impact on life expectancy
People with severe mental illness die between 10 and 20 years earlier than the general population - an equivalent or greater impact on life expectancy than heavy smoking (which, on average, reduces life expectancy by eight to 10 years). Poor physical health and nutrition is thought to be responsible for many of the deaths, according to a study by Oxford University psychiatrists published in the journal World Psychiatry.

More than half of young people link mental illness with alienation and isolation
56% believe that anyone their age diagnosed with a mental illness would be treated differently, and 55% believe they would lose friends.

More than half of young people feel embarrassed 51% of young people believe that anyone their age diagnosed with a mental illness would be embarrassed. The findings from a YouGov/MQ survey also show a high level of mental health problems in students, as more than a quarter (27%) report having a mental health problem of one type or another. Female students are more likely to say they have mental health problems than males (34% v 19%).

Just 6% of UK health research spending goes on mental health
This is despite mental health disorders such as anxiety, depression, phobias and post-traumatic stress disorder affecting one in four of the population.

For every person affected by mental illness, £8 is spent on research - 22 times less than cancer and 14 times less than dementia
UK funding for mental illness research equates to £8 per person, according to research from mental heath research charity MQ, compared with £178 per person for cancer and £110 for dementia.

Less than 30% of mental health research is focused on young people
Only £26m a year is earmarked for children and young people's studies, despite 75% of mental illness starting before the age of 18. The lack of investment in children's mental health means that very little is known about the cause of mental illness, and which treatments are most effective.

You can help change these stats. Swear to help MQ in taking on mental illness in young people - and support pioneering research to transform lives.

In the UK, the Samaritans can be contacted on 116 123.
In the US, the National Suicide Prevention Hotline is 1-800-273-8255.
In Australia, the crisis support service Lifeline is on 13 11 14.

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12 statistics to get you thinking about mental health in young people

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16 million people in the UK experience a mental illnessOne in four adults will experience a mental illness at some point each year in the UK. This ranges from anxiety and depression to alcohol dependence, substance misuse and psychosis.

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NICE PATHWAYS

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LUKE'S STORY

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Psychosis: information for parents, carers and anyone who works with young people

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Psychosis: helping your child to get better: up to date, easy to read information by the Royal College of Psychiatrists as part of the Mental Health and Growing Up factsheet series

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Early Intervention for young people with psychosis

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Early Intervention in Psychosis and specialist Child and Adolescent Mental Health Services

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Reducing Duration of Untreated Psychosis Through Rapid Identification and Engagement

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Overview

Reducing Duration of Untreated Psychosis (DUP) is a primary goal for improving long-term outcomes in young people with a first episode of psychosis (FEP). The "standard of FEP care" within the US focuses on targeted provider education regarding signs and symptoms of early psychosis to motivate patient referrals to FEP services, followed by initiation of services within largely clinic-based settings Experience at the Early Diagnosis and Preventive Treatment (EDAPT) FEP specialty program at U.C. Davis in Sacramento has identified two important bottlenecks to reducing DUP, consistent with reports in the literature from other FEP clinics. These are 1) delays in the identification of psychotic symptoms by referral sources, and 2) delays or disruptions of patient engagement in specialty FEP care. Building upon a comprehensive and established referral network of 20 sites across the Sacramento area (schools/universities, ER/inpatient hospitals, outpatient mental health, primary care), the investigators will address delays in patient identification and engagement using a two-phase, cluster randomized design. The investigators will consecutively test the impact of two interventions to reduce DUP, defined in this RFA as time from first onset of psychotic symptoms to engagement in FEP specialty care. To address identification delays, the investigators will examine the use of standard targeted provider education plus novel technology-enhanced screening compared to standard targeted provider education alone, testing the hypothesis that the education plus technology-enhanced screening will identify more patients, earlier in their illness. To address engagement delays, the investigators will compare the use of a mobile community-based, telepsychiatry-enhanced engagement team to standard clinic-based procedures for intake, engagement and initiation of treatment, to test the hypothesis that the mobile approach facilitates earlier and more stable engagement, thereby reducing DUP. The proposed work will provide new specific evidence-based practices for reducing DUP and improving outcomes through specialty care of individuals with a first episode of psychosis.

Study Type

Study Type: Interventional

Study Design

Allocation: Randomized

Intervention Model: Parallel Assignment

Primary Purpose: Screening

Masking: Single (Outcomes Assessor)

Study Primary Completion Date: December 2018

Interventions

Other: Electronic Screen + Education (Phase 1)
PHASE 1 Electronic Screening Arm + Targeted Education: Referral sources will receive the same standard targeted education as active comparator. In addition, the PQ-B (a 21 item screening questionnaire) will be administered to all patients at their first visit to the referral sites (e.g. intake) via an android tablet provided to the site for ease of administration and scoring. The investigators will provide multiple tablets per site so that the screening is available for more than one individual simultaneously and can be completed in any appropriate location. The investigators will allow paper-and-pencil administration for situations where it is more appropriate (e.g. emergency room).

Other: Targeted Provider Education (Phase 1)
PHASE 1 Targeted Education Intervention: EDAPT standard targeted provider education1 focuses on increasing awareness about the signs of early psychosis & building collaborative relationships with community members so community members see EDAPT as a rapid, effective source of help. It consists of a 2-hour workshop describing: 1) how to identify specific early symptoms & changes associated with the onset of psychotic illness, 2) the benefits of early intervention on treatment outcomes in psychosis, 3) the structure, philosophy & treatment model of the EDAPT Clinic, and 4) procedures for expeditious referral to our program. Case-based vignettes are reviewed to ensure understanding of the key symptoms.

Other: Community Mobile Engagement (Phase 2)
PHASE 2 Community-based Mobile Engagement: Clinical assessment appointments will take place at the EDAPT clinic or within the community, wherever the individual would prefer. With patients deemed eligible for EDAPT services, the EDAPT clinician will obtain vitals and contact the EDAPT psychiatrist with a telemedicine-enabled laptop to complete the psychiatric evaluation remotely. The psychiatrist will prescribe medications and order labs, as indicated. The EDAPT clinician will follow up with the individual within 5 days to determine if the prescribed medication regimen has started.

Other: Clinic based Engagement (Phase 2)
PHASE 2 Clinic-based Engagement: The clinical assessment appointment will be completed within the EDAPT clinic. If deemed eligible for EDAPT services, the individual will be scheduled for a clinic-based appointment with the EDAPT psychiatrist within 5 days, who will prescribe medications and order labs as indicated. The EDAPT clinician will follow up with the individual within 5 days of the psychiatric evaluation (by phone or in the clinic) to determine if the prescribed medication regimen has started.

Arms, Groups and Cohorts

Experimental: Electronic Screen + Education (Phase 1)
Electronic screening of participants and targeted education of providers according to standard EDAPT model.

Active Comparator: Targeted Provider Education (Phase 1)
Targeted education of providers according to standard EDAPT model.

Experimental: Community Mobile Engagement (Phase 2)
Clinical intake interviews take place via videoconference at a location in the community convenient for the participant.

Active Comparator: Clinic based Engagement (Phase 2)
Clinical intake interviews take place at the EDAPT clinic.

Clinical Trial Outcome Measures

Primary Measures

Days of active psychosis between onset of illness and identification for care (Duration of untreated psychosis)

Secondary Measures

Rates of patient enrollment in first episode psychosis care

Participating in This Clinical Trial

Inclusion Criteria

Meet DSM-IV criteria for a diagnosis of affective or nonaffective psychosis.

Exclusion Criteria

1. Duration of psychosis > 2 years

2. Current substance dependence

3. Neurological illness or injury leading to psychotic symptoms

4. Only substance induced psychotic symptoms

5. Documented IQ < 70

6. Lack of English fluency

Gender Eligibility: All

Minimum Age: 12 Years

Maximum Age: 30 Years

Are Healthy Volunteers Accepted: No

Investigator Details

Lead Sponsor
University of California, Davis

Collaborator
National Institute of Mental Health (NIMH)

Provider of Information About this Clinical Study

Information Source

ID Number: 104235

NCT Identifier: NCT02841956

NCT02841956,

Clinical trials entries are delivered from the US National Institutes of Health and are not reviewed separately by this site. Please see the identifier information above for retrieving further details from the government database.
https://trialbulletin.com/lib/entry/ct-02841956

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Reducing Duration of Untreated Psychosis Through Rapid Identification and Engagement: Psychotic...

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Reducing Duration of Untreated Psychosis (DUP) is a primary goal for improving long-term outcomes in young people with a first episode of psychosis (FEP). The standard of FEP care within the US focuses on targeted provider education regarding signs and symptoms of early psychosis to motivate...

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Hannah

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The NHS funding crisis is disproportionately impacting mental health care provision. Less than a third of the NHS Tusts that responded to my FOI request were able to offer psychosis patients the full...

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Post by NormanLambLibDem.

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EIP is the first mental health area to receive waiting times standards like they have in cancer and a lot of other physical health.

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EIP is the first mental health area to receive waiting times standards like they have in cancer and a lot of other physical health.

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Hannah

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Psychosis patients not getting the early intervention care package they need..

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Psychosis patients not getting the early intervention care package they need..

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Charlotte
http://www.bbc.co.uk/news/health-42892630